Friday, January 29, 2010

If You Can't Build Your Bones, Build Your Vocabulary

Ladies, did you know that you can no longer build bone after menopause? Once you reach that splendid milestone, you've stuck with the bones you've got. Oh, sure, I know that ads for drugs such as Boniva promise that you can stop and even "reverse" bone loss, but you'll never get back the bones you had when you were a giddy young thing in your twenties.

I was diagnosed with osteoporosis in April, 2000, when I was 59. I was put on Fosamax (10 mg/day) and stayed on it for nearly 10 years. The day my sister fractured her left femur in mid-November by bumping into a wheelchair ( it was parked by the door to be returned to the rental store two months after her foot surgery), I vaguely remembered a report I'd read in the summer of 2008 suggesting that long-term use of Fosamax appeared to be associated with "low-energy" femur fractures like my sister's. As soon as the anesthetic from her femur surgery wore off, my sister was sitting up in bed with her laptop,  busily researching femur fractures on the internet. When I fractured my own femur two weeks later,  I became just as interested as she was in finding out all I could about Fosamax and femur fractures. Fortunately, my sister sent me about a dozen articles by doctors who are researching the Fosamax/femur-fracture connection.

The most notable quote from the stack of articles: "Their physician had them on Fosamax believing it was a relatively benign drug used to treat osteoporosis," says Dr. Lorich. "What we found was that the patients having these fractures had been on the bisphosphonate for several years, and it was turning their bone off from healing." From Orthopaedic Trauma Today, Premier Issue, Spring 2008.

My industrious sister also found an on-line support group of 30 women and 1 man who had all taken Fosamax for at least four years and who had all all sustained low-energy fractures of their femurs (some bilateral). One unfortunate person experienced both bilateral femur fractures and osteonecrosis (jaw bone death), another suspected side-effect of long-term Fosamax use.

Anyway, medical dictionary in hand, I have carefully read all the articles and the stories provided by  the members of the online support group and have learned many new words:

bisphosphonates:   drugs such as Fosamax, Boniva, Actonel

bone turnover:  the breakdown of old bone (by osteoclasts) and the creation of new (by osteoblasts). Bisphosphanates are thought to interfere with this natural process.

comminuted:  a fracture in which the bone breaks into many small pieces

cortex:  the outer layer of the bone

diaphyseal:  refers to a fracture of the shaft of the femur

femur:  the thigh bone

hypertrophy: overgrowth, thickening (of the cortex). The bone may appear strong on a bone scan, but actually be quite brittle.            
IM rod: intramedullary rod. Metal rod implanted surgically that replaces the marrow of the femur and stabilizes the bone

low-energy fracture: a fracture that occurs from a standing height or less, which normally would not happen unless the bone were severely diseased or very brittle

osteoblast: cells that build up new bone

osteoclast: cells that break down old bone

osteonecrosis: bone death. In the bisphosphonate context, jaw-bone death. Merck, the maker of Fosamax, has been sued by dental patients who took Fosamax and whose jaw bones collapsed or developed open wounds after dental procedures.

osteopenia: the thinning of bones that occurs naturally with aging, which may progress to osteoporosis in time.

stress reaction: a microscopic disruption in the bone that is not repaired, eventually resulting in a fracture

subtrochanteric:  refers to to a femur fracture occuring below the lesser trochanter. See trochanter.

trochanter: bony structure(s) on top of thigh bone shaft, close to the hip. There are actually two trochanters, the greater and the lesser. 

Sunday, January 24, 2010

Bone Pome

Femur, fyemur, foemur, fummer,
Hope I walk OK next summer.
If I can't, then what a bummer!
Femur, fyemur, foemur, fummer.

Saturday, January 16, 2010

Six Weeks' Check Up

I saw Dr. Alam yesterday for my six-weeks' check-up. The x-rays show that the bone is mending nicely. The doctor was pleased with my mobility, but he said I should hold off on driving for another two weeks. :-(

When I mentioned that I needed a "left-handed" cane, he looked puzzled. I showed him the cane I'd been using. It had belonged to Mom. She picked it out because it did not look like an "old lady" cane. At age 97, she was not about to go out in public looking like an old lady.  Instead of a crook, her cane had a molded handpiece of black simulated wood, making it look more like an Irish walking stick than a cane.  It was her idea of a  compromise, because she didn't "need" a cane at all and was only getting one to shut me (and her doctor) up. Since it was molded to fit her right hand, it was all wrong for me. Here's a bit of "arcane" knowledge: if your right leg is injured, you hold your cane in your left hand, and vice-versa.  Dr. Alam gave me an "old lady" cane and I went home happy.

On Monday, I will start outpatient physical therapy, three times a week for four weeks.

Saturday, January 9, 2010

Progress (of sorts) Report

Next Friday I have an appointment with my surgeon. It will be six weeks since my  surgery to "rod" a broken femur. I hope he gives me a green light on driving. Starting the week of January 18th, I will have outpatient physical therapy two or three times a week for four weeks. I would like to be able to drive myself rather than imposing on Phil.

I've definitely turned the corner on pain. It's now a "one" on a scale of one-to-ten, with ten being the worst. Although there were times when, even on morphine, the pain seemed more like a "fifteen," those days are over. Now my complaint is stiffness. I feel like the Tin Man in the Wizard of Oz after a cold, drenching rain. Does anyone have an oilcan? I have all but abandoned the walker around the house. I get around by holding onto things if I need to. Otherwise I just hobble along, looking like a drunken sailor on a tossing ship. It would be nice to walk more or less gracefully again.